title: Lack of a tachycardic response to hypotension with ruptured ectopic pregnancy.
abstract: The concept that tachycardia is a reliable indicator of shock has recently been challenged in patients with hemoperitoneum. The purpose of this study was to document whether patients with ruptured ectopic pregnancy manifest a tachycardic response to hypotension and to define the relationship between hemodynamic response and blood loss resulting from hemoperitoneum. A retrospective chart review of 154 patients with documented ectopic pregnancy identified 20 (13.0%) hypotensive patients (systolic blood pressure less than or equal to 90 mm Hg). Eleven (55%) patients were not tachycardic (pulse rate less than 100 beats/min) and nine (45%) patients were tachycardic. The quantity of hemoperitoneum varied widely in each group and did not correlate with the hemodynamic response. These results support the proposed theory that hemoperitoneum may trigger a parasympathetic reflex, resulting in a pulse rate inappropriate for the degree of hypotension. A vasovagal reflex may play a role in those patients without significant hemoperitoneum. The diagnosis of hypovolemic shock must be considered when hypotension is present without tachycardia.
authors.affiliation: Department of Emergency Medicine, Albany Medical Center Hospital, NY 12208.
authors.forename: H S
authors.initials: HS
authors.lastname: Snyder
mesh_terms: D004630:Emergencies; D005260:Female; D006339:Heart Rate; D006465:Hemoperitoneum / Q000150:complications / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D007022:Hypotension / Q000175:diagnosis* / Q000503:physiopathology; D011247:Pregnancy; D011271:Pregnancy, Ectopic / Q000150:complications*; D012189:Retrospective Studies; D012422:Rupture, Spontaneous; D012769:Shock / Q000175:diagnosis* / Q000209:etiology; D013610:Tachycardia / Q000503:physiopathology*; D014630:Vagus Nerve / Q000503:physiopathology